Click here to download NRCAC Reimbursement Instructions

NRCAC Training Expense Reimbursement

If you are completing this reimbursement form on behalf of another person, please check this box and complete the additional fields. 

 

Requestor Information

First Name

Please only write one name in this field. If you are completing this form for multiple people, please add their names in the "notes" section by clicking "Yes" next to "Do you have any other expenses that are not listed above?" x

Last Name

Please only enter one name in this field. x

Email Address

Request Information

First Name

Last Name

Email 

*Please use the attendee's (not requester's) email address. x

Title

Organization/Agency

Event Name

Please select... All-Nations Conference on Child Maltreatment LEC Medical Preceptorship Multidisciplinary Team Academy NCA Chapter Summit NRCAC Chapter Summit Team Facilitator 2.0 Training Vicarious Trauma Victim Advocacy Other

Event Date

Start Date of Event x

Event Location

If other, please name the event here.

Expense Breakdown

Receipts are required for all reimbursement items other than meal per diems and mileage. Without receipts you will not be reimbursed. Copies of boarding passes are required for all air and train travel. Reimbursement forms and receipts must be submitted no later than thirty days after the event for which reimbursement is being requested. 

Enter numbers without dollar signs for all fields.

Registration

Copy of paid registration confirmation & certificate of attendance/completion required x

Air/Train Fare

Coach class; receipt & copy of boarding pass required x

Baggage Fees

Receipts required x

Parking 

Receipts required; tips/gratuities are not able to be reimbursed x

Taxi, Uber/Lyft or Shuttle

Receipts required; tips/gratuities are not able to be reimbursed x

Tolls

Receipt or EZPass statement required x

Personal Mileage

Enter total # of miles for round trip travel - map required!!

Personal Mileage Amount

Auto-calculated: total miles x $0.655/mile

Lodging

Only government per diem rates can be reimbursed; receipt showing the room rate before taxes/fees is required. x

If your hotel is over the federal per diem rate, no part of the hotel cost may be reimbursed. Please contact NRCAC or check www.gsa.gov/perdiem for current rates.

Do you have any other expenses that are not listed above?

Yes

No

Other Expenses (total cost of other expenses WITHOUT dollar sign)

Explanation of expense required below.

Notes (cost breakdown for other expenses)

Please use Notes section below to describe the above listed expense. x

Total Reimbursement

Check Details

Check should be made out to

Street Address

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

ZIP Code

Our parent organization, Philadelphia Children's Alliance, utilizes Bill.com to pay all reimbursements. During the reimbursement process, you will be sent an invitation to create a secure payment profile with Bill.com, where you will be able to select on Bill.com whether you would like to be sent a paper check to the above address or receive an ACH payment direct deposited into your account. If you have already received reimbursements from NRCAC/PCA through Bill.com, you should use the same Bill.com account.

Please enter the email address that should receive the invitation for your Bill.com profile, or is associated with your existing profile:

Receipts

Please use this area to attach your documents (receipts, boarding passes, mileage maps, etc.) 

One combined PDF attachment is preferred! 

NOTE

If you are submitting two separate forms for reimbursement to yourself and your organization/agency, please only include the back up documentation that pertains to the record you are submitting.

File types accepted are: PDF, JPG, PNG x

NRCAC is supported with funds awarded through OJJDP Grant Award Number 15PJDP-22-GK-03061-JJVO.

Boarding passes & receipt for coach class ticket purchase are attached to this request.

Yes	I am not requesting air or train fare

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Contact Information

Northeast Regional Children’s Advocacy Center
Philadelphia Children’s Alliance
300 East Hunting Park Ave
Philadelphia, PA, 19124

Executive Director
Philadelphia Children’s Alliance
Benita Williams
bwilliams@philachildrensalliance.org

NRCAC Project Director
Teresa Smith
Teresa@nrcac.org

Training Specialists
Sue Ascione
Sue@nrcac.org

Michele Mullen
Michele@nrcac.org

Tony DeVincenzo
Tony@nrcac.org

Project Initiatives Specialist
Ilana Lezama-Beausejour
Ilana@nrcac.org

Project Manager
Katelyn Waltimyer
Katelyn@nrcac.org

Project Coordinator
Brittany Ramos
Brittany@nrcac.org

Communications Manager
Myia Hill
Myia@nrcac.org

Not sure who to contact, but have something to say? NRCAC welcomes your feedback!
Please use this form to reach out anonymously.

Accessibility:
The Northeast Regional Children’s Advocacy Center is committed to the accessibility of its electronic and information technologies for individuals with disabilities by meeting the requirements of Section 508 of the Rehabilitation Act. Section 508 requires that individuals with disabilities have access to and use of information and data that is comparable to those who are not individuals with disabilities, unless an undue burden would be imposed on us. More information on Section 508 can be found at www.section508.gov.

Questions:
If you have feedback or concerns related to the accessibility of this website and resources contained within it, please contact us via email at admin@nrcac.org.

NRCAC is supported with funds awarded through OJJDP Grant Award Number 15PJDP-22-GK-03061-JJVO